LOGO APPLICATION FORM
Africa Executive MBA
 
All information in this form will be treated as confidential and will only be used by CEIBS Admission Committee. Please note: * the asterisk indicates required information
 
Application Checklist
Application Form
Photocopies of all degree certificates(certificated tanslations if degree is not in English
Corporate Sponsorship Letter or Letter of Support
Non-refundable Application fee: $150.00 or equivalent in New Ghana Cedis
C.V
Two Passport pictures
Copy of Business Card
 
1.Personal Information
Please fill in with a check mark: * Mr. Ms.  
Last Name * First Name *
Date of Birth * Place of Birth *
Country * Nationality *
 
2.Permanent Address
Street P.C.Box
Town/City Post code
Country Home Phone
Mobile Phone * Fax
E-mail(must be valid until programme start) *
 
3.Business Address
Street P.C.Box
Town/City Post code
Country * Home Phone
Mobile Phone Fax
E-mail(must be valid until programme start) *
*Please keep us informed, should your contact information change during the application process.
How would you prefer us to communicate with you?
By post By e-mail By telephone By fax
 
4.Academic Background
Please indicate below the three most important and recent degrees you have completed in reverse chronological order.
Level of highest degree obtained :
PhD/Doctorate Master's Undergraduate  
Duration from to Name of University Field Degree Full/Part time
 
5. Please indicate the area in which you obtained your bachelor's degree
Science (e.g.Biology, Chemistry, Information, Computer)
Health & Medicine (e.g. Medicine, Pharmaceuticals, Dentistry, Veterinart)
Engineering(e.g.Electrical, Industry, Architectural, Building, Mechanical)
Social Science(e.g. Economics, Laws, Social Science, Political Science)
Business & Management (e.g. Management, Mangement Information System, Business Administraion)
Arts & Humanities (e.g. History, Lanuage, Arts)
Otheres(e.g. Agriculture, Education, Nedia, etc)Please specify
In which language was your university degree taught?
 
6. Professional Background
Please list each full-salaried position after your first degree obtained in reverse chronological order, starting with your most
recent position and accounting for any gaps.
 
a) Current position *  
Duration from To Company City Country Position Gross annual salary GHC or Uss

Briefly summarize your current job responsibilities:
Number of employees in subsidiary
Name and number of employees worldwide of parent company
Company Sector Job Function
Do you belong to a project team?
 
b) Previous work exerience  
Duration from To Company City Country Position Gross annual salary GHC or Uss

 
Total duration in years of full-time positions held (by the beginning of the EMBA program)
Of which years in a leadership
position and
in international
assignments
 
7. English Language Proficiency *
To be admitted to the CEIBS AFRICA program, you must be fluent in English.
Applicants who have a degree from an institution in an English speaking country are exempt from submitting the TOFEL.
The same applies to applicants whose mother tongue is English.
Please indicate in the table below the level at which you situate your proficiency in English.
Use the following for self-assessment.
Level 1 The ability to participate in a conversation about daily life
Level 2 The ability to understand, speak and write with structural accuracy, communicate and read newspaper,
as well as to give adequate information about future career goals
Level 3 The ability to conduct business in English
Level 4 The ability to interact in any circumstances with the near-ease of a native speaker
Level 5 Native language
 
8. Financing Your Studies *
If selected for admission to the CEIBS Africa EMBA program, how will your tuition be funded?
Tuition funded by company % Amount
Tuition funded by yourself % Amount
Tuition funded by other sources % Amount
Please indicate the other sources of funding (name of institution)
 
9. How did you learn about the CEIBS Africa Executive MBA? *
Current employer Print media article Advertisement (please specify)
Career adviser CEIBS(Africa) website Alumnus/Alumna (please specify)
CEIBS(Africa) information Session Colleague/friend.relative Conference of Fair (Please specify)
Other Website (please specify) Other (please specify)
 
10. Why did you choose CEIBS Africa Executive MBA? *
Please indicate the reasons for applying for this program. In your opinion, what differentiates us from other programs?
Before submitting your application, please use the checklist on the beginning of the application form to unsure that your
application material is ready. We encourage you to talk to your employer before applying for the program.
   
Statement of Accuracy
I hereby certify that the information contained in this application is complete and correct to the best of my knowledge.
Date     Applicant's Signature